CHRONIC DISEASE -TREATMENT AT

HOME

Continuous Home Peritoneal Dialysis

Bożena Pietrzak
Old patients > 65 CHRONIC
DIALYSIS PROGRAMME
 24% of the patients

PERITONEAL HOME
dialysis
In chronic renal disease…
- the star of the
peritoneal dialysis
 Dialysis should be initiated when the
creatinine clearance falls to a certain lower
limit, usually about 10 ml/min/1,73m2 ( in
diabetes 20 ml/min/1,73m2)

 The need for dialysis should be anticipated

in order to allow proper patient
training and peritoneal access
Examples „without /with
the machine”

 PD – peritoneal
dialysis
 CHPD- Continuous
HOME Peritoneal
Dialysis
 Manual or with the
machine „home
choice” : CAPD or
APD
Home as the place for the medical
procedurę -very important

 Information for patient and his family

 Initial education (more information)

 Acceptation patient with/without

family
 Training

 Equipment
and

 Monitoring
of the chronic
programme of treatment
 Results
 Adequacy

 Therapeutic decision –
doctor, nurse
Why patient and/or family
refused the form of treatment at
home ?
Patient Family
 Fear for
procedure  Fear
 Fear for
for
complications medical
 Fear for family procedure
members
Chronic dialysis

 Peritoneal dialysis-CAPD
or APD as the method
of CHPD (Continuous
Home Peritoneal Dialysis)
 Patients for whom chronic
peritoneal dialysis is usually
favored over hemodialysis :
 Patients with severe cardiovascular
disease
 Patients with difficult vascular access
(e.g.diabetics, old ond very old patients)
 Infants or very young children
 Patients who desire greater freedom to
travel
 Patient who wish to perform home
peritoneal dialysis
Chronic home PD in
special patients
In the In
elderly diabetics
At home – they have been
successfully treated with
chronic peritoneal dialysis
Home dialysis
What are the reasons for
conducting dialysis at
home?
 Cost

Home dialysis
+ C E
E N
is less N D
PE
expensive D E
IN
 INDEPENDENCE
1. Most patients feel a considerable sense of
achievement in managing their own dialysis and their
lives
2. They can arranged their schedule to fit around their
work
3. The schedule can be altered for social or recreational
activities
4. Problems of travel to the center are largely eliminated
5. For the patient living a great distance from a center ,
home care may represent the only alternative to a
total change in life style
 By what criteria are patients
selected for home dialysis?
1. The prospective patient must have sufficient
emocional stability to tolerate the dialysis
treatment
2. There must be minimally adequate physical
facilities in the home (space,water,
electricity) to accommodate the equipment
3. There should be a family member at home ,
one with not only interest and wilingness but also
with a stable psychologic approach , who can
assist the patient with dialysis over an indefinite
period
Does the patient have to live
near a training center?
 At most centerrs distance is not a
major factor
 It may be necessary during the
training period to live temporarily
away from home
 The patient achieve the greatest
degree independence and self-care
 Many patients have been succesfull
Can the patient ‘s
private /or xxx physician
continue to care
for him ,
even though the
physician has no
training in dialysis?
YES BUT
 Itis difficult : dietary
management,
 The patients  control of blood
and his pressure and the
family variety of problems
member they may occur as a
learn and result of disordered
perform the metabolism
dialysis
 DOCTOR is not

expected to manage
the details of dialysis
 He can and often
 Patient and does ,supervise a
his family significant portion of
the medical
member learn management of the
and perform patient
the dialysis
exchanges
Physician find this a
challenge and because of
personal knowledge of
the home situation are
able to provide excelent
patient and family
support
What are the goals of
home dialysis?
 There are the essentially the
same as the goals for any
rehabilitation program:
 to prevent further disability
 to restore capability
 to return, if neccessary , the individual
for constructive life
How long does it take for
patient for a family to train for
home dialysis?
 Length of time varies with the
training center, the type of equipment
and the patient
 All training programms are geared to
the indyvidual and his or her ability
to assimilate the material to
conduct dialysis with safety
and confidence
 What does home dialysis
training involve?
 There are variation between training
centers
 In most there is
one training
person to one patient
 Audiovisual aids such as movies , slide
presentations,film-strips and videotape
programs to cover introductory and background
material or specific points are widely used
ATTENTION
 The teaching of technic is step-by-step
procedure, with a reason beeng given for each
step until the trainer both performs and
understands why that step exists
 Programmed study books are used
 Any program must be designed
 Upon completing training the patient has
confidence that he/she can conduct
dialysis adequately and that the person
who trained him/her is likewise confident
of the patient ability
AT HOME

 Most centers have printed

materials describing their
individual technics and
procedures
 Many centers prepared
newsletters or bulletins
 The patient and his motivation
to learn home dialysis
 It is important that the patient be in
sufficiently good physical and chemical state
to be capable of understanding what is
underteaken
 The patient must be ready to learn
 It is very important that the patient
be motivated positively by the desire
for self care and to resume an active life
The special role of the
patient and his family helper
 Patient is responsible for the
dialysis procedure
 The family helper/member is
taught to be the patient”s
assistant and to know
emergency procedure
 Duringthe training
course the patient and
one member of his family
(helper) is prepared to
perform dialysis
 How is the transition from
training center to home
accomplished

1. One or more visits to the

home will have been
made by center personnel
during the training period
2. Most often personnel from the
center will be present at the
first dialysis at home to ensure
that equipment and supplies
are ready and that all goes well
during the actual procedure
In Poland….
1.Only patient and his family helper
are at home
2.Only family members are prepared
the home
3.Nurses can help the patient only in
a hospital every six weeks (control
visit)
4.The patient can asked the nurse
any question about complications
by the telephone every day
 CAPD training course - the example

I
Performing of the dialysis exchange

II exchange + Recognition of
the complication

Rec.of + Innitial
III exchange +
the complication treatment
The basic subjects of the education

Doctor Nurse Information about the

diet
exchange
General principle
UF
ES care
Analysis of tha meals
Manual efficiency from the last 3 days

peritonitis Exaaples – haw to

(
prepare – special
workshoop
ESI
Doctor,nurse and
specialist of the feeding
 Reeducation
 Is very important diuring dialysis
programme
 Nurses and physicians describe the
clinical complications for the procedure
 Reeducation should be continued
during all the time of dialysis
programme
Emergencies or
complication at home
 Mechanical
 Medical
 Infections
 Peritonealaccess
 Serious change in physical
condition
Is home dialysis possible if
there is no family member
to assist?
 Training for the sameone other
than a family member is possible

 Person who had completed a

training course in dialysis including
use of heparin and with
demonstrated ability to assist
What is self-care dialysis?
 There is a compromice between home and
center dialysis
 When for various reasons patient cannot be
dialyzed at home
 There is a center with a number of dialysis
station
 Patient is responsible for the major portion
of the setup and clean up of equipment
 Patient is responsible for the self monitoring
of the procedure
How is the patient
prepared for self care?
 Training similar to that at
home dialysis
 There is limited or no
professional assistance
Advantage

 Stress for family members

is less
 Continuous dialysis
programme is possible
Disadvantage

Cost – greater
Travel to self
-care unit
 Limited –care dialysis
 Unit is out of hospital
 Orientation toward self-
care with a minimum staff
 In some instanses full-
service
Limited –care or self-care
or home dialysis
Some patient because
of physical problems,
language barriers or
ather difficulties can
with self-care not cope
Home dialysis in different
countries
***Poland-only CHPD
(Continuous Home Peritoneal
Dialysis) = CAPD (Continuos
Ambulatory Peritoneal
Dialysis), APD (Automated
Peritoneal Dialysis) patient
with/without family member
Normal Exit Site of The Peritoneal Catheter
CHPD training of the blind diabetic patient

Only with voice and hands

Chronic home PD in
special patients
In the In

elderly diabetics
Home patients have been
successfully treated with
chronic peritoneal dialysis
Home
dialysis
What are reasons for conducting dialysis
at home?

 Cost
Home dialysis
C E
is less expensive
and thereafter about one-third
E N
D
that of center dialysis

E N
E P
IN D
 e
ak
ist
m
PD at home
Home delivery
Special
cooking
book
for PD
home
patients
Complications of the PD
home programme
Loss of the ultrafiltration
 Peritonitis

CLAUDY DIALYSATE
Malnutrition, cahexia in
PD
PD home basic equipment
and exit/ catheter care
(dressing)
Thank you
for your attention